Tricking Trichotillomania

You secretly pull out your hair. Sometimes you play with the hair. Other times you may eat it. You may have bald patches and you occasionally wear a wig. No one knows that you engage in this behavior. You just feel relief when you pull out a few hairs. You may have trichotillomania.

Trichotillomania is obsessive-compulsive disorder of tugging and pulling of hairs until they break. About 5 to 10 million people, roughly 3.5 percent of the population meet the clinical criteria for trichotillomania. People with other obsessive-compulsive disorders can’t control impulses to constantly wash their hands, count things or engage in other repetitive behaviors.

Experts think that compulsive behaviors like hair pulling may be caused by an imbalance of chemicals in the brain. These chemicals, called neurotransmitters, are a part of the brain’s communication center. When something interferes with how the neurotransmitters work, it can cause problems like compulsive behaviors.

Trichotillomania affects about twice as many girls as guys. Most teens who have trichotillomania develop the condition during adolescence, but it can start as young as 1 year old. Teens with this disorder tend to pull hair out by the roots from places like the scalp, eyebrows, eyelashes, or pubic hair. Some teens may pull large handfuls of hair, which can leave bald patches on the scalp and eyebrows. Other teens may pull a strand at a time. Some inspect the strand after pulling it out or play with the strand after it’s been pulled. About half of teens with the condition put the hair in their mouths after pulling it.

Trichotillomania isn’t just a habit a person can easily stop. It is a medical condition-a type of compulsive behavior, which means that patients with the condition feel an overwhelming urge to pull their hair. People with trichotillomania may experience other compulsive behaviors such as nail biting or skin picking. Some may have problems like depression, anxiety, or obsessive-compulsive disorder (OCD). Such compulsive behaviors can sometimes run in families.

Trichotillomania often leads to embarrassment, frustration, shame, or depression; self-esteem problems are very common. They usually try to hide the behavior from others, which can make it difficult to get help. Doctors aren’t sure what causes trichotillomania, but some think it is related to OCD since they are both anxiety disorders. This is one reason why the impulses that lead to hair pulling can be stronger when a person is stressed out or worried.

Sometimes compulsive behaviors happen when the mind mistakenly thinks that activities like hair pulling will provide relief from stress or other problems. Some patients with trichotillomania say that they notice a pleasurable feeling when they pull their hair or get relief from uncomfortable feelings. Any relief that comes from hair pulling usually only lasts for a moment. The urge almost always returns. That’s because when the mind becomes used to giving in to powerful urges, the behavior is reinforced. The mind gets trapped in a cycle of expecting to have the urge fulfilled.

Since the urge behind compulsive behaviors like hair pulling are so powerful, a person may feel more tension or anxiety when first trying to resist the urge. That is why it helps to work with an expert who can offer support and practical advice about overcoming the problem. Some doctors may prescribe medications that can help the brain better deal with urges, making them easier to resist. Medication therapy can also help to correct the imbalance of chemicals in the brain. Many people find it helpful to keep their hands busy with a different activity (like squeezing a stress ball or drawing) during times when pulling is the worst.

Most effective has been the use of drugs like Prozac (fluoxetine) which increase serotonin levels in the brain. This and other drugs like clomipramine, often make patients more aware of their behavior, the first step towards changing it. Some patients, however, find that the drugs stop for a short time before the urges return. Even if these drugs, which are antidepressants, do not stop the hair pulling, many say they provide a significant emotional uplift. Other patients consider their side effects worse than the affliction.

Exercise and other stress relievers like meditation can cut those urges. More formal therapy involves learning to substitute behavior like clenching your fist for three minutes when the urge hits you. Some research indicates that a combination of therapies is useful in treating trichotillomania (e.g. hypnosis and meditation).

Trichotillomania may crop up when a child is going through a stressful time, such as dealing with a parent’s death or changing schools and may be triggered by hormones. But the definitive cause is unknown. The disorder can result in suicide if negative feelings are not overcome.

If you or a loved one is suffering from trichotillomania, please see your doctor as soon as possible. You and your doctor can work on ways to suppress the urge to pull your hair. Your doctor may suggest a support group to join, a space where you can express yourself among people who share the same experience of pulling hairs.